Video-assisted mediastinal lymph node dissection assessed in an experimental setting

Background: Feasibility, completeness, and morbidity of videoscopic-assisted mediastinal lymph node dissection (VATS MLND) were compared to the standard surgical technique in an experimental study. Methods: Right upper MLND-together with upper lobectomy in half of the cases-was performed in ten large white pigs. Six animals were operated using VATS (group 1), four using conventional open techniques (group 2). After 1 week, the animals were sacrificed and the mediastinum was assessed for remaining lymph nodes. Results: All animals survived without intra- or postoperative complications. There was no significant difference in the operation time between the two groups (3.2 +/- 0.8 vs 3.2 +/- 0.2 h). The number of mediastinal lymph nodes harvested was 9.5 +/- 2.7 in group 1 and 11.5 +/- 0.5 in group 2 (n.s.). The post-mortem assessment of the mediastinum showed in two animals of group 1 and in two animals of group 2 that one lymph node was left behind. In addition, in one animal of group 1 four small retrotracheal lymph nodes were found. Conclusions: VATS MLND can be accomplished without morbidity and is as radical as that achieved with conventional surgery in the paratracheal and peribronchial areas in this experimental setting. However, retrotracheal lymph node dissection might not be as complete as achieved by conventional surgery.